Author + information
- Jim W. Cheung,
- Salvatore A. D'Amato,
- Steven Markowitz,
- Christopher Liu,
- George Thomas,
- James E. Ip,
- Parmanand Singh and
- Bruce Lerman
Background: Despite continuous treatment with non-vitamin K antagonists (NOACs) and warfarin, the rate of left atrial thrombus (LAT) detection by pre-procedure transesophageal echocardiograms (TEEs) in patients with atrial fibrillation (AF) undergoing catheter ablation and cardioversion is not zero. The optimal treatment strategy and rates of LAT resolution for these pts are unknown.
Methods: We evaluated 500 consecutive patients on ≥ 4 weeks of continuous oral anticoagulant (OAC) therapy undergoing TEE prior to catheter ablation (n = 392 [78%) or cardioversion (n = 108 [22%]) for treatment of AF or atrial flutter. Patients with LAT who had further follow up TEE imaging were identified. Baseline demographic data were collected. Data including OAC therapy prior to LAT detection at index TEE, changes to OAC therapy after LAT detection, and dates and results of all TEEs performed after the index TEE were recorded.
Results: Twenty-three pts (mean age 65 ± 11 years, 83% male) who were found to have LAT underwent repeat TEE imaging. Eleven (48%) pts were on NOACs (7 on dabigatran and 4 on rivaroxaban) and 12 (52%) pts were on warfarin for median 12 (IQR 7, 24) months prior to index TEE. Repeat TEE was performed after median 3.0 (IQR 2.0, 4.2) months. Nine (39%) patients had resolution of LAT on the first repeat TEE while an additional 5 (22%) patients had resolution of LAT on a repeat TEE performed median 3.9 (IQR 3.4, 4.0) months later. Overall, 14 (61%) patients had eventual resolution of LAT. Of the 12 pts initially on warfarin, 6 (50%) were switched to NOACs and had a LAT resolution rate of 50% while 6 (50%) remained on warfarin had a LAT resolution rate of 67%. Of the 11 pts initially on NOACs, 6 (55%) were switched to warfarin and had a LAT resolution rate of 33% while 5 (45%) remained on NOACs and had a LAT resolution rate of 100%.
Conclusions: In this study, despite alterations in treatment, over a third of patients with LAT were found to have persistent LAT after serial TEEs. Of the patients who did have eventual resolution of LAT, a substantial number of these occurred only after > 6 months. Studies to identify the optimal anticoagulation regimen and timing of assessment for LAT resolution are needed.
Moderated Poster Contributions
Arrhythmias and Clinical EP Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 1:30 p.m.-1:40 p.m.
Session Title: Stroke and AF: Thinking About the Heart
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1223M-11
- 2017 American College of Cardiology Foundation